APA's new Ethics Code, its values and excellence in psychological services

By
DR. STEPHEN BEHNKE APA Ethics Director

July/August 2004, Vol 35, No. 7

Print version: page 88

The previous "Ethics Rounds" examined the relationship in our Ethics Code between the General Principles and the Ethical Standards. While this relationship can be reduced to its most basic element--general principles are aspirational, ethical standards are enforceable--such a reduction misses the code's richness and coherence. Last month's column focused on how a value central to the code, respect for individuals' right to self-determination, permeates the standards and promotes good clinical care. This "Ethics Rounds" explores how other principles underpin the standards and how standards negotiate between sometimes competing principles to benefit our clients and protect them from harm.

Fidelity and responsibility

Principle B, Fidelity and Responsibility, states that psychologists "are concerned about the ethical compliance of their colleagues' scientific and professional conduct." Ethical Standard 1.05, Reporting Ethical Violations, codifies the values behind this principle by stating that psychologists take appropriate action when they learn of a colleague who has engaged in behavior that has resulted, or is likely to result, in substantial harm.

Standard 1.05 creates an exception when "an intervention would violate confidentiality rights." As an example, this exception may arise when a client relates a sexual involvement with a previous psychologist; the treating psychologist is then faced with an ethical dilemma that requires choosing between the principle of fidelity and responsibility, on one hand, and confidentiality, on the other.

Standard 1.05 resolves the dilemma by giving priority to confidentiality. Note how, in doing so, the code protects the client's right to self-determination by placing in the client's hands the choice of whether and how to respond to the ethics violation. The code also protects the psychologist-client relationship by not exposing the treatment to an unwanted breach in its boundary. Balancing these considerations against the important goal of protecting the public, the code promotes the integrity of the treatment relationship and thereby enhances the ability of the psychologist to meet the individual client's clinical needs.

Integrity

Principle C, Integrity, begins "Psycho ogists seek to promote accuracy, honesty and truthfulness in the science, teaching and practice of psychology." Ethical Standard 8.07, Deception in Research, addresses when psychologists may employ methodologies that are not entirely accurate, honest or truthful. Our field has an illustrious history of studies examining human behavior, many carried out by social psychologists, in which the true nature or purpose of the study was not initially revealed to the subjects. The tension between the advancement of science, on one hand, and accuracy, honesty and truthfulness, on the other, is an excellent example of an ethical dilemma.

Standard 8.07 addresses this dilemma by defining four conditions under which psychologists may advance science by using deception: the value of the study justifies the deception; effective nondeceptive procedures are not available; deception is not used when the study is reasonably expected to cause pain or severe emotional distress; and the deception is explained to participants as early as is feasible, no later than the end of data collection.

By limiting the use of deception to specific circumstances and requiring that psychologists reveal the deception "as early as is feasible," the code both promotes the advancement of science and recognizes the importance of accuracy, honesty and truthfulness. By privileging the advancement of science, the code encourages psychologists to continue research that, in our current social and geopolitical circumstances, is vital. By limiting the use of deception, as much as reasonably possible to allow for the advancement of science, the code protects individuals from harm, a value central to our ethics.

Justice

Principle D, Justice, begins "Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology...." The second section of the Ethical Standards is titled "Competence," whose first standard, "Boundaries of Competence," begins "Psychologists provide services...only within the boundaries of their competence." This statement embodies a central concept in Principle A, Beneficence (doing good) and Nonmaleficence (not doing harm); an incompetent provider may cause harm. A tension thus arises between Principle D, on the one hand, and Principle A and Standard 2.01, on the other, when individuals request or require services that no available psychologist is competent to provide.

Standard 2.01(d) addresses this tension by providing that psychologists "with closely related prior training or experience may provide such services in order to ensure that services are not denied." Standard 2.01(d) attenuates the tension by stating that psychologists may provide services in these circumstances "if they make a reasonable effort to obtain the competence required by using relevant research, training, consultation or study."

Note how Standard 2.01(d) privileges the principle that all persons should have access to and benefit from psychological services. At the same time, Standard 2.01(d) recognizes the tension between providing services to all individuals and the possibility of harm that arises when service providers are not competent in the particular treatment.

Standard 2.01(d) navigates this tension by limiting which psychologists may provide services in such circumstances and by ensuring that such psychologists make reasonable efforts to obtain the necessary competence. By so navigating the tension, the code maximizes the number of individuals who receive services from psychologists who have, or are on the cusp of having, the requisite competence.

Respect for rights and dignity

Principle E, Respect for People's Rights and Dignity, begins "Psychol ogists respect the dignity and worth of all people, and the rights of individuals to privacy [and] confidentiality...." Principle A, Beneficence and Nonmaleficence, begins "Psychologists strive to benefit those with whom they work." Ethical Standard 4.06, Consultations, promotes both of these principles by explicitly recognizing the importance of consulting with colleagues and stating that, when consulting, psychologists do not disclose individually identifiable information without prior consent. Standard 4.06 recognizes that a tension will sometimes arise between beneficence and confidentiality, for example when a psychologist must reveal identifying information for a consultation to be effective and so helpful to the work.

Standard 4.06 privileges beneficence over confidentiality in such a circumstance by stating that the psychologist may reveal identifying information during a consultation without consent if "the disclosure cannot be avoided." While Standard 4.06 gives beneficence priority over confidentiality, it protects confidentiality by stating that if confidential, identifying information is revealed during a consultation, with or without consent, psychologists "disclose information only to the extent necessary to achieve the purposes of the consultation." Standard 4.06 thus addresses an ethical dilemma by giving clear weight to one principle (beneficence), and elaborating that as much of the other principle (respecting an individual's right to privacy and confidentiality) is preserved as can be. Standard 4.06 negotiates between these two principles in a manner that promotes good clinical care by ensuring that psychologists can obtain consultations for their work, and that a lack of consent will not prevent a psychologist from receiving necessary assistance.

Examining the relationship between the Ethics Code's general principles and ethical standards reveals a coherence and integrity to our code. The code functions as a whole to protect the individuals and groups with whom psychologists work, as the Preamble states. The different parts of the Ethics Code work together to allow and encourage psychologists to provide services that benefit our clients, our profession and our understanding of human and animal behavior. Understanding our Ethics Code as a dynamic, coherent whole reveals a code that promotes excellence in the services psychologists provide.